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Objective: Youth who receive services in residential programs have high rates of traumatic exposure and associated symptoms of Posttraumatic Stress Disorder (PTSD). Little information is available on specific social skills training that could be beneficial for youth in residential programs with PTSD. This study examined changes in behavioral incidents and psychopathology in youth receiving group home services based on training they received across three categories of social skills (i.e., self-advocacy, emotional regulation, problem-solving). Method: The sample included archival data on youth (N = 677) ages 10-18 years (M = 15.7 years, SD = 1.53). Hierarchical Linear Modeling was used to examine the frequency of disruptive and self-injurious behaviors over 12 months as it relates to reported traumatic symptoms at admission and the presence of the three types of social skills objectives. Analysis of Covariance was conducted to test whether the social skill objectives differentially predicted changes in youth psychopathology from intake to discharge for youth with low and high trauma symptoms. Results: Youth with high trauma symptoms who received training on problem-solving skills had significantly greater decrease in emotional problems from intake to discharge compared to youth with high trauma symptoms who did not receive problem-solving training (d = -0.54). Conclusion: Problem-solving training could be further developed and tested to maximize the support youth with trauma symptoms receive in trauma-informed residential programs.

This study conducted a randomized trial to examine the efficacy of the Boys Town In-Home Family Services (IHFS) program for families of high-risk youth. Participants were recruited from a state helpline for families struggling with poor family functioning and child emotional or behavioral issues. Consent was obtained for 300 of which 152 were randomly assigned to participate in IHFS for 3-4 months and 148 were assigned to the services as usual comparison group. For the families in the treatment group, 18% did not participant in the intervention, and 66% of families received 20 or more service hours. Parent report data were collected at intake, post, as well 6 and 12 months after post data collection. Data were collected on constructs such as caregiver strain, family functioning, parenting, family resources, and parent report of child behavior. Piecewise analyses of the intake to post data indicated significantly greater reductions in caregiver strain for the treatment condition. Given the conservative corrections for the use of multiple tests, no other measures demonstrated significant differences. For the piecewise model of the maintenance phase, there were no significant differences between groups aside from caregiver strain that showed a significant improvement for the comparison condition. Supplementary dose-response analyses indicated that for most families there was an ideal dosage of about 25-75 hr to bring about the largest improvements in caregiver strain, parenting skills, and child behavior.

A better understanding of how childhood adversity (CA) patterns influence the effectiveness of Trauma Informed Care (TIC) for youth in residential programs is needed. Utilizing a longitudinal design, the study examined how CA patterns influenced aggression and self-injurious behavior during treatment and emotional and conduct outcomes for 1,343 racially diverse adolescents in a TIC residential program. Latent class analysis identified five CA patterns. Subsequent mixed, two-factor ANCOVAs indicated youth from all CA patterns experienced parallel decreases in emotional problems from intake to discharge while changes in conduct problems during this same period differed by CA pattern. Likewise, Hierarchical Linear Modeling revealed that youths' self-injurious behavior and aggressive behaviors over the first 12 months of the program also differed by CA pattern. Some demographic differences based on sex and race were found, which are discussed in turn. Findings indicate that while the program is functioning as TIC, more tailored support is needed for youth with specific CA patterns and demographics. Trauma-informed practices are important for improving emotional well-being in residential care. Tailored interventions for youth with specific trauma histories may help reduce self-injurious behavior and behavior problems. TIC programs may better serve youth with a variety of trauma histories by incorporating interventions that target social development. [ABSTRACT FROM AUTHOR]

Psychometric properties of the 30-item Family Resource Scale (FRS) were examined in a sample of families seeking assistance for their child's behavioral difficulties (N = 300). The FRS is a measure that assesses the adequacy of family resources across several contexts including intra-family support and personal resources. Our analyses supported a modified 29-item four-factor solution ("basic needs," "extra money and time," "time for family," and "essential") compared with the seven-factor solution provided by the developers. Results showed that families' perception of their resources as adequate across all domains was associated with better family functioning and less caregiver strain. Combined, our findings suggest modifications to the existent structure of the FRS.

There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a residential care program, and the extent to which caregiver experience and youth time-in-program mediated that relationship. The study used archival data for 1,438 first-time admissions to a large Midwestern out-of-home residential program for youth with emotional and behavioral problems. Hierarchical Linear Modeling was used to examine the relationship between daily reports of conduct and oppositional defiant disorder (CD/ODD) behaviors and the percentage of conduct disorder youth living in a home. Greater exposure to conduct disordered peers was not related to increased rates of CD/ODD behavior. CD/ODD behavior was directly related to direct care staff level of experience and youth time in program. Implications for residential care are discussed.

Students with persistent disruptive behavior problems lose valuable time in academic lessons, are a distraction for classmates, and cause stress for teachers. Recent meta-analyses indicate that 87% to 92% of published studies on school-based interventions targeting student problem behaviors report results from demonstration projects (involving highly trained staff under ideal circumstances) rather than routine practice programs. This study investigates the routine use of a schoolwide classroom management program and its relationship to elementary students' social and academic outcomes. Three years after training in the classroom management program, 56 second-, third-, and fourth-grade teachers in an urban school district were assessed for fidelity to the program. Program fidelity was determined via direct observation in the classroom and validated by teacher self-ratings of fidelity and administrator ratings of teacher fidelity. Dependent variables included student engagement during academic lessons, out-of-school suspension rates, and report card grades. Results indicated that high program fidelity was significantly related to greater academic engagement and fewer suspensions, but not higher report card grades. This study adds to the scant literature on implementation fidelity of routine programs with high-risk populations. (Contains 6 tables.)

We describe over 300,000 crisis calls made to a large national hotline over a 5-year period. Callers consisted of males and females between the ages of 10 and 89. Overall, a slight majority of callers were first time callers (52%) and most (73%) sought assistance with issues related to parenting, youth concerns, and mental health. Across the lifespan, issues dealing with loneliness increased with age whereas depression-related calls decreased. Additionally, females were more likely than their male counterparts to call the hotline by over a 2- to 1-margin. Findings lend preliminary support to the efficacy of crisis call centers to utilize a flexible, yet well-defined problem-solving approach to assist those of all ages calling with the wide range of problems.

This study examined the impact of therapeutic alliance (TA) on therapy outcomes for youth with behavioral and emotional problems residing in residential care. Study participants were 71 youth in an out-of-home family-style residential treatment facility who were referred to an onsite psychotherapy clinic. A therapeutic alliance scale was completed independently after each session by the youth and their therapist. Two outcome measures were used: a symptom scale that was completed by the youth before each therapy session, and a daily observational measure made by direct care staff of all significant events for each youth. Youth symptoms improved significantly over the course of therapy and their behaviors decreased to a rate similar to their peers. TA ratings, however, were only marginally related to therapy outcomes. Implications for assessing therapeutic alliance in child therapy are discussed. (Contains 2 tables and 3 figures.)

Objective: The number of youth in residential care programs who have been abused is high. The relationship between childhood abuse victimization and adult intimate partner violence (IPV) is well documented. This study compared the rates of IPV 16 years after individuals had participated in a long-term residential care program with individuals accepted to the program who did not participate. The IPV rates for these two groups were also compared to national normative data. Method: Information on adult functional outcomes was obtained from former residential care and comparison youth via a confidential survey that was administered either by telephone or by mail. Analysis was limited to respondents who were currently married or involved in a marriage-like relationship (n=131; 92% male). Results: The IPV rates for the sample were 9.3% for those who stayed in the residential program less than 18 months and 6.5% for those who stayed more than 18 months, neither of which were significantly different from the national norm of 8.4%. The IPV rate for the comparison group was 26.1%, which was significantly higher than the national norm. Regardless of length of program stay, respondents who were maltreated in childhood had a 14.5% IPV rate, which was significantly lower than the estimated 36-42% rate projected for individuals with similar backgrounds. Conclusion: We conclude that time spent in a treatment-oriented residential care program was associated with lower adult IPV rates. Specifically, the skills taught in a long-term, treatment-based residential program (e.g., healthy interpersonal relationships, self-government) may have a long-term beneficial impact for adolescents at high risk of adult IPV.

This article describes the process that youth in a large residential out-of-home care program complete as they prepare for the transition into adulthood. This process is geared toward preparing these young people through a series of structured real-life activities and lessons. Results from a separate 5-year follow-up study indicate that those who completed this process report more positive functional outcomes than those who did not. Also addressed is the importance of effective after-care services to help these young adults maintain the gains established during treatment. (Contains 2 tables.)

This study documents the initial reliability and validity of the Child Suicide Risk Assessment (CSRA) for children under the age of 13. The revised CSRA retained 18 of 20 original items based on item-specific psychometric data from 140 pre-adolescents in out-of-home treatment programs. The CSRA demonstrated adequate internal consistency (alpha = .69) for a multi-dimensional scale (3 factors: Worsening Depression, Lack of Support, and Death as Escape). CSRA scores correlated significantly with criterion measures of prior suicide attempts and ideations. A receiver operating characteristic (ROC) curve discriminated significantly between prior attempters and non-attempters and was used to select preliminary CSRA cut-off scores for identifying substantial suicide risk. The CSRA is the first screening measure of suicide risk in pre-adolescents validated by associations with suicide attempts as well as ideations.

Objective: The number of youth in residential care programs who have been abused is high. The relationship between childhood abuse victimization and adult intimate partner violence (IPV) is well documented. This study compared the rates of IPV 16 years after individuals had participated in a long-term residential care program with individuals accepted to the program who did not participate. The IPV rates for these two groups were also compared to national normative data. Method: Information on adult functional outcomes was obtained from former residential care and comparison youth via a confidential survey that was administered either by telephone or by mail. Analysis was limited to respondents who were currently married or involved in a marriage-like relationship (n = 131; 92% male). Results: The IPV rates for the sample were 9.3% for those who stayed in the residential program less than 18 months and 6.5% for those who stayed more than 18 months, neither of which were significantly different from the national norm of 8.4%. The IPV rate for the comparison group was 26.1%, which was significantly higher than the national norm. Regardless of length of program stay, respondents who were maltreated in childhood had a 14.5% IPV rate, which was significantly lower than the estimated 36-42% rate projected for individuals with similar backgrounds. Conclusion: We conclude that time spent in a treatment-oriented residential care program was associated with lower adult IPV rates. Specifically, the skills taught in a long-term, treatment-based residential program (e.g., healthy interpersonal relationships, self-government) may have a long-term beneficial impact for adolescents at high risk of adult IPV. Keywords: Intimate partner violence; Residential care; Cycle of abuse; Intergenerational cycle of abuse; IPV

This study investigated changes in hope among 155 youths (ages 10 to 17 years) placed in a residential treatment facility over a 6-month period. The child and adolescent participants met criteria for a range of emotional and behavioral disorders and received interventions hypothesized to improve hopeful thinking. Hope scores significantly improved over 6 months of treatment. The positive changes in hope were not moderated by ethnicity or sex. For Agency hope scores (i.e., willpower), those with higher levels of psychopathology at admission demonstrated significantly more improvement in agency thinking over the course of 6 months. Keywords: residential care, hope theory, clinical outcomes

This study documents the initial reliability and validity of the Child Suicide Risk Assessment (CSRA) for children under the age of 13. The revised CSRA retained 18 of 20 original items based on item-specific psychometric data from 140 pre-adolescents in out-of-home treatment programs. The CSRA demonstrated adequate internal consistency ([alpha] = .69) for a multi-dimensional scale (3 factors: Worsening Depression, Lack of Support, and Death as Escape). CSRA scores correlated significantly with criterion measures of prior suicide attempts and ideations. A receiver operating characteristic (ROC) curve discriminated significantly between prior attempters and non-attempters and was used to select preliminary (CSRA cut-off scores for identifying substantial suicide risk. The CSRA is the first screening measure of suicide risk in pre-adolescents validated by associations with suicide attempts as well as ideations.

Agencies providing our-of-home mental health services for troubled adolescents are facing tougher challenges. Many psychiatric units have been relegated to short-term crisis intervention, so the number of youths with severe [...]

Psychometric properties of the 30-item Family Resource Scale (FRS) were examined in a sample of families seeking assistance for their child's behavioral difficulties (N = 300). The FRS is a measure that assesses the adequacy of family resources across several contexts including intra-family support and personal resources. Our analyses supported a modified 29-item four-factor solution (basic needs, extra money and time, time for family, and essential) compared with the seven-factor solution provided by the developers. Results showed that families' perception of their resources as adequate across all domains was associated with better family functioning and less caregiver strain. Combined, our findings suggest modifications to the existent structure of the FRS. [ABSTRACT FROM AUTHOR]